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Many UK healthcare professionals still “panic” when they come across a case of female genital mutilation (FGM), according to a leading specialist midwife who has called for improvements to training and services.

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In its report – titled Maternal Request Caesarean – it claimed the majority made the process of requesting a caesarean “lengthy, difficult or inconsistent”, which it said added “anxiety and distress to women at a vulnerable time”.

In addition, it warned that lawyers acting for the charity were concerned that at least one trust may be acting unlawfully.

It noted that National Institute for Health and Care Excellence guidelines said that when a woman requested a caesarean section, discussions should be had and specific reasoning for the request should be recorded.

For example, they state: “For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option [trusts should] offer a planned caesarean section.”

It said the guidelines also suggested that when a discussion was had regarding a caesarean section, other members of the obstetric team could be included “if necessary, to explore the reasons for the request, and ensure the woman has accurate information”.

“Women must be given the information to explore their views and feelings about caesarean birth”

Gill Walton

But a Freedom of Information Act carried out by the charity revealed that 15% of trusts that replied had policies or processes that explicitly did not support maternal request caesareans.

Meanwhile, it said 47% of trusts that replied had polices or processes that it described as problematic or inconsistent.

In fact, it said its research found only 26% of trusts that responded to the FOI request offered caesareans in line with the guidance from NICE.

The charity claimed it had also found that pregnant women in some regions who asked about the procedure were being told to go elsewhere.

The charity’s chief executive, Rebecca Schiller, said she believed that maternal requests for caesareans were “the number one reason” that women contact the charity advice service.

“Unfortunately, parent education is now a Cinderella service in many NHS trust maternity units”

Susan Baines

She said: “The women we support have endured previously traumatic births, physical ill-health, childhood sexual abuse or have carefully examined the evidence available and made informed decisions that planned caesareans will give them and their baby the best chance of an emotionally and physically healthy start.

“It is clear that women requesting caesareans meet judgemental attitudes, barriers and disrespect more often than they find compassion and support,” said Ms Schiller.

“We are concerned that this lack of respect for patient dignity could have profound negative consequences for the emotional and physical safety of women” she added.

Gill Walton, chief executive and general secretary of the Royal College of Midwives, said she supported the NICE recommendations and guidelines that “midwives and doctors work with”.

Ms Walton said she believed that midwives have an “important role in supporting women” who may request a caesarean section and urged midwives to discuss the risks and benefits.

New chief executive takes over at midwives’ union

Gill Walton

“Midwives should listen to women who want a caesarean section and discuss the risks and benefits of caesarean section and physiological birth in a way that is understandable and accessible to them,” she said.

“Women must be given the information to explore their views and feelings about caesarean birth, to enable them to come to an informed decision about their preferred type of birth,” she noted.

“This information should reflect the individual woman’s current and previous medical, obstetric and psychological history,” she added.

Susan Baines, a lecturer in midwifery and applied healthcare ethics at the University of Salford, called on trusts to ensure women could “choose what they feel is best for them”.

“That has to begin with well-informed education for prospective parents. Unfortunately, parent education is now a Cinderella service in many NHS trust maternity units and now tends to be outsourced to other agencies – some of which may not be aware of the latest guidance,” she said.

“If more emphasis was placed on the education of women, I feel as a childbirth educator that women would be able to consider their options and choices far more confidently,” said Ms Baines.

She noted that caesarean section was a “major operation” and that the NHS needed to try to “normalise birth as much as possible”, but not with cost as a driving factor.

“Women should be able to choose the method of birth they feel is the right one for them after being provided with the evidence,” she said.

She added: “The rise in Caesarean sections is a sign of the times for some women who wish to be in control of every aspect of their lives, but women who are very anxious about childbirth should not be stigmatised as their fears are very real to them.”

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